Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries. Weakening of the pelvic muscles that leads to uterine prolapse can be caused by:

Damage to supportive tissues during pregnancy and childbirth

Effects of gravity

Loss of estrogen

Repeated straining over the years

If you have mild uterine prolapse, treatment usually isn't needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.

Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:

Sensation of heaviness or pulling in your pelvis

Tissue protruding from your vagina

Urinary problems, such as urine leakage or urine retention

Trouble having a bowel movement

Low back pain

Feeling as if you're sitting on a small ball or as if something is falling out of your vagina

Sexual concerns, such as a sensation of looseness in the tone of your vaginal tissue

Symptoms that are less bothersome in the morning and worsen as the day goes on

Weakening of pelvic muscles and supportive tissues contribute to uterine prolapse. This may happen as a result of:

Pregnancy

Trauma during childbirth

Delivery of a large baby

Difficult labor and delivery

Loss of muscle tone

Less circulating estrogen after menopause

Certain factors may increase your risk of uterine prolapse:

One or more pregnancies and vaginal births

Giving birth to a large baby

Increasing age

Frequent heavy lifting

Chronic coughing

Prior pelvic surgery

Frequent straining during bowel movements

Genetic predisposition to weakness in connective tissue

Being Hispanic or white

Some conditions — such as obesity, chronic constipation and chronic obstructive pulmonary disease (COPD) — can place a strain on the muscles and connective tissue in your pelvis and may play a role in the development of uterine prolapse.

Possible complications of uterine prolapse include:

Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.

Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.

Make an appointment with your family doctor or gynecologist if you have signs or symptoms of uterine prolapse that bother you or interfere with your normal activities.

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

Write down any symptoms you've had and for how long.

Make note of key medical information, including other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.

Bring a friend or relative along, if possible. Having someone else there may help you remember important information or provide details on something that you missed or forgot.

Write down questions to ask your doctor, listing the most important ones first in case time runs short.

During your appointment, don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

What symptoms are you experiencing?

When did you first notice these symptoms?

Have your symptoms gotten worse over time?

Is your condition painful? If yes, how severe is your pain?

Does anything in particular trigger your symptoms, such as coughing or heavy lifting?

Do you experience urine leakage (urinary incontinence)?

Have you had a chronic or severe cough?

Is heavy lifting involved in your work or daily activities?

Do you strain during bowel movements?

Are you currently being treated or have you recently been treated for any other medical conditions?

What medications are you taking, including over-the-counter and prescription drugs as well as vitamins and supplements?

Did any family members — such as your mother or sister — experience uterine prolapse or other pelvic problems?

How many children have you delivered? Were your deliveries vaginal or cesarean?

Do you wish to have children in the future?

Do you have any other concerns?

Tests or exams to diagnose uterine prolapse include:

Pelvic exam. During this exam, your doctor may ask you to bear down as if having a bowel movement, which can help your doctor assess how far the uterus has slipped into your vagina. To check the strength of your pelvic muscles, your doctor may ask you to tighten (contract) them, as if you're stopping the stream of urine. You may be examined while lying down and while standing up.

Questionnaire. You may fill out a form that helps your doctor assess how uterine prolapse affects your quality of life. This information also helps guide treatment decisions.

Imaging tests, such as an ultrasound or magnetic resonance imaging (MRI), aren't generally needed for uterine prolapse. But they're sometimes helpful in assessing the degree of prolapse.

If you have mild uterine prolapse, either without symptoms or with symptoms that don't bother you, you probably don't need treatment. However, your pelvic floor may continue to lose tone, making uterine prolapse more severe as time goes on. Check back with your doctor to monitor the extent of your prolapse and review your symptoms.

Vaginal pessary. This device fits inside your vagina and holds your uterus in place. Used as temporary or permanent treatment, vaginal pessaries come in many shapes and sizes. Your doctor measures and fits you for the proper device. You'll learn how to insert, remove and clean the pessary. You may be able to take the pessary out overnight and reinsert it each day; other pessaries can be left in place for longer periods of time.

But a vaginal pessary may be of little use if you have severe uterine prolapse. A pessary also can irritate vaginal tissues, possibly to the point of causing sores (ulcers) on vaginal tissues, and it may interfere with sexual intercourse.

In some cases, minimally invasive (laparoscopic) surgery is a possibility. This procedure involves smaller abdominal incisions, special surgical instruments and a lighted camera-type device (laparoscope) to guide the surgeon.

Which surgery and surgical approach your doctor recommends depends on your individual needs and circumstances. Each procedure has pros and cons that you'll need to discuss with your surgeon.

If you plan future pregnancies, you might not be a good candidate for surgery to repair uterine prolapse. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair. Also, for women with major medical problems, the risks of surgery might outweigh the benefits. In these instances, pessary use may be your best treatment choice for bothersome symptoms.

Talk with your doctor to learn your options, including the benefits and risks.

Depending on the severity of your condition, these self-care measures may help with uterine prolapse:

Hold the contraction for five seconds, then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.)

Work up to holding the contractions for 10 seconds at a time.

Do three sets of 10 repetitions each day.

Ask your health care provider for feedback on whether you're using the right muscles. Kegel exercises may be most successful when they're taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time.

Once you've learned the proper method, you can do Kegel exercises discreetly just about anytime, whether you're sitting at your desk or relaxing on the couch.

Although uterine prolapse isn't always preventable, you may be able to decrease your risk if you:

Perform Kegel exercises on a regular basis. These exercises can strengthen your pelvic floor muscles — especially important after you have a baby.

Treat and prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grain cereals.

Reprint Permissions

A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.